Delaying the control of blood pressure among middle-aged adults with diabetes
Research Activities, December 2012, No. 388
Long delays in controlling blood pressure among middle-aged adults with diabetes can lower quality of life, concludes a new study. The University of Chicago researchers estimated the harms of different delays in controlling blood pressure in a hypothetical population of 10,000 middle-aged adults (aged 50 to 59) with newly diagnosed type 2 diabetes. With a lifetime of uncontrolled systolic blood pressure, complications increased by 1,855 events per 10,000 patients, average life expectancy decreased by 209 days, and average quality-adjusted life expectancy (QALE) decreased by 332 days, compared to a population with newly diagnosed diabetes who had a lifetime of controlled systolic blood pressure (130 mmHg). The average rates of stroke and heart attack increased the most compared to other complications, such as end-stage renal disease (diabetes damages the kidneys) and diabetes-related amputations.
A 1-year delay in controlling systolic blood pressure increased lifetime complications by 14 events per 10,000 patients, with a range between 0 and five events per 10,000 patients for specific complications. A 1-year delay did not affect average life expectancy, but it decreased QALE by 2 days. A 10-year delay increased lifetime complications by 428 events per 10,000 patients, and decreased QALE by 145 days. The researchers estimated that delays in blood pressure control of 10 years or more in this group of patients with diabetes are expected to lower QALE to the same extent as smoking in patients with cardiovascular disease.
Given the current size of the diabetes population in the United States, the study findings suggest that achieving and maintaining tight blood pressure control earlier among U.S. middle-aged adults with diabetes has the potential to generate substantial population-level health benefits. This study was supported in part by the Agency for Healthcare Research and Quality (HS16967).
See "Impact of delaying blood pressure control in patients with type 2 diabetes: Results of a decision analysis" by Neda Laiteerapong, M.D., Priya M. John, M.P.H., David O. Meltzer, M.D., and Elbert S. Huang, M.D., in the June 2012 Journal of General Internal Medicine 27(6), pp. 640-646.